If you’ve completed, or are about to complete, a course of Transcranial Magnetic Stimulation (TMS) for depression, you might be wondering what comes next. A recent systematic review offers valuable insights into what researchers call “preservation TMS” – any TMS treatment used to maintain the benefits after a successful initial course.
Why Do We Need Preservation TMS?
Major Depressive Disorder (MDD) is typically a chronic condition, affecting over 300 million people worldwide (about 4.4% of the global population). It’s the single largest contributor to non-fatal health loss, with economic costs in the U.S. alone estimated at $210.5 billion. The impact is even greater for those with treatment-resistant depression (TRD), which is typically defined as having failed at least two adequate antidepressant medication trials.
TMS is a highly effective treatment, with results typically lasting 1-1.5 years. Studies have shown that utilizing preservation TMS after the initial course of treatment is complete can prolong the initial results of treatment, so that relapse is less likely.
What Does the Research Show?
The systematic review examined 30 studies involving 1,494 patients. The researchers found strong evidence for both the safety and effectiveness of preservation TMS, though they note that more research is still needed to determine the optimal approach.
One significant study followed patients for six months after their initial TMS treatment. Of 99 participants who had responded to TMS, 38% experienced symptom relapse. However, when these patients received additional TMS treatments, 84% regained their improvement. By the end of the six-month period, only 10% of the original participants had experienced a full return of their depression.
Another year-long observational study at 42 clinical sites found that among 120 patients who initially responded to TMS, 49% received one or more repeat TMS sessions during follow-up. Impressively, 62% maintained their improvement throughout the entire year.
Different Approaches to Preservation TMS
The review identified several specific strategies being used:
1. Scheduled Treatments:
- Some protocols use a single TMS session per month
- Others use clusters of 5-10 treatments over several days each month
- Some start with more frequent sessions and gradually taper the frequency
2. Symptom-Triggered Approach:
- Patients are monitored regularly for depression symptoms
- Additional TMS sessions begin when symptoms start to return
- Treatment continues until the patient returns to their previous level of improvement
When Should Preservation TMS Begin?
The review suggests two main approaches based on when symptoms return:
1. If symptoms return after more than a year of wellness, a new complete course of TMS is recommended.
2. If symptoms return within a year, either:
- Another complete course of TMS, or
- A preservation TMS strategy using either clustered treatments or a tapering schedule
Monitoring and Assessment
Regular monitoring is crucial for successful preservation TMS. The frequency of monitoring should be based on:
- The severity of your previous depression
- Your clinical history
- How quickly your symptoms tend to worsen
- Your history of seeking care when symptoms return
The Future of Preservation TMS
While the research shows promising results, the review emphasizes that more studies are needed to:
- Determine optimal treatment schedules
- Identify which patients are most likely to benefit
- Develop personalized approaches
- Understand the long-term effects of extended TMS treatment
Key Takeaways
- Preservation TMS is safe – no additional safety concerns were found even with extended treatment
- Multiple approaches exist and can be tailored to individual needs
- Regular monitoring is essential for catching any symptom return early
- Previous success with TMS is a good predictor of future response
- Not everyone will need maintenance treatments, but they’re a valuable option for those who do
At Texas 360 TMS, we will guide you through the entire process of TMS, even after your first round of sessions is complete. If you have any questions regarding the TMS process, please feel free to give us a call at 512-360-0805, email us at info@texas360tms.com, or schedule a free initial consultation on our home page!
Works Cited
Wilson, S., Croarkin, P. E., Aaronson, S. T., Carpenter, L. L., Cochran, M., Stultz, D. J., & Kozel, F. A. (2021). Systematic review of preservation TMS that includes continuation, maintenance, relapse-prevention, and rescue TMS. Journal of Affective Disorders, published online September 2021. doi:10.1016/j.jad.2021.09.040
